Polycystic ovary syndrome

Differential diagnoses include diabetes mellitus and metabolic syndrome because patients with these conditions share several similar characteristics with Cushing s syndrome patients (e.g., obesity, hypertension, hyperlipidemia, hyperglycemia, and insulin resistance). In women, the presentations of hirsutism, menstrual abnormalities, and insulin resistance are similar to those of polycystic ovary syndrome. Cushing s syndrome can be differentiated from these conditions by identifying the classic signs and symptoms of truncal obesity, "moon faces" with facial plethora, a "buffalo hump" and supraclavicular fat pads, red-purple skin striae, and proximal muscle weakness. 

The use of metformin and thiazolidinediones for anovulatory bleeding associated with polycystic ovary syndrome is beneficial for anovulatory bleeding and fertility and also improves glucose tolerance and decreases overall cardiovascular risk. 

Table 46-1 illustrates the pathophysiology of amenorrhea relative to the organ system(s) involved, as well as the specific condition that results in amenorrhea. Amenorrhea is also a normal side effect that may result from the use of low-dose oral contraceptives (OCs), extended-cycle OC pill use, or depot medroxyprogesterone acetate use.5 Many women may experience delayed return of menses after discontinuation of OCs. Postpill amenorrhea usually is a self-limited condition. Further evaluation for other unrecognized conditions, such as polycystic ovary syndrome (PCOS), should be considered if spontaneous resolution of the amenorrhea does not occur within 3 to 6 months following discontinuation of the OCs.6,7... 

BMD, bone mineral density NSAID, non-steroidal anti-inflammatory drug OCs, oral contraceptives PCOS, polycystic ovary syndrome PMDD, premenstrual dysphoric disorder. 

American College of Obstetricians and Gynecologists. Polycystic ovary syndrome. ACOG Practice Bulletin number 41. Obstet Gynecol 2002 100 1389-402. 

Guzick DS. Polycystic ovary syndrome. Obstet Gynecol 2004 103(1) 181-193. 

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome. Fertil Steril 2004 81(l) 19-25. 

Amenorrhoea, which refers to the absence of menstruation, is associated with anorexia nervosa, polycystic ovary syndrome and congenital adrenal hyperplasia. The condition requires referral. 

Polycystic ovary syndrome endocrine disorder characterised by amenorrhoea, hirsutism and infertility Porphyria inherited disorders presenting with increased production of porphyrins in the bone marrow Prostatic hyperplasia enlargement of the prostate Pseudomembranous colitis diarrhoea occurring in patients who received antibacterial agents, caused by the resulting overgrowth of anaerobic bacteria in the gastrointestinal tract... 

Women with anovulatory infertility should be offered full endocrinological evaluation, considering potential diagnoses such as hypothalamic-pituitary disease, polycystic ovary syndrome and primary gonadal disease. Hyperprolactinaemia must be sought as a potential cause, and its treatment is outlined below. The main treatments available include the anti-oestrogens clomiphene and tamoxifen, and gonadotrophin therapy. 

Women with the polycystic ovary syndrome are at increased risk for the metabolic syndrome and associated health risks and metformin, which also reduces hyperinsulinemia, might be effective in treating obese, infertile women with the polycystic ovary syndrome. 

Abdelmageed E, Fayed M, Sharaf M. Letrozole induction of ovulation in clomiphene citrate resistant polycystic ovary syndrome responders and non-responders. Middle East Fertility Soc J 2004 9 2. 

Guzick DS. Treating the polycystic ovary syndrome. N Engl J Med 2007 356(6) 622-4. 

Nugent D, Vandekerckhove P, Hughes E, Arnot M, Lilford R. Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev 2000. 

Rasgon, N.L., Altshuler, L.L., Gudeman, D., Burt, V.K., Tanavoli, S., Hendrick, V., and Korenman, S. (2000) Medication status and polycystic ovary syndrome in women with bipolar disorder a preliminary report. / Clin Psychiatry 61 173-178. 

The THEiTHF + 5aTHF ratio is commonly greater than 15 in these disorders, the opposite to AME syndrome. While the ratio of saturated steroids demonstrates a high 11-oxo l 1/1-hydroxy ratio, this is not the case for steroids retaining a - -4-ene structure. The F E ratio is normal or elevated (i.e., > 1 Table 5.3.9). Steroid profile analysis also typically reveals an elevated excretion of DHEA and other androgen metabolites. Clearly the excessive ACTH production resultant from an apparent cortisol deficiency is responsible for the elevated adrenal androgen production, which in turn is responsible for female virilization and other manifestations of polycystic ovary syndrome. 

A person typically ingests daily about one gram of inositol, some in the free form, some as phosphoinositides, and some as phytin. As much as four grams of inositol per day may be synthesized in the kidneys.22 Breast milk is rich in inositol and dietary supplementation with inositol has increased survival of premature infants with respiratory distress syndrome.22 The action of insulin is reported to be improved by administration of D-c/zzro-inositol (p. 998) to women with polycystic ovary syndrome.223... 

We have also come to understand that many complex diseases such as diabetes, polycystic ovary syndrome,385 Crohn s disease (inflammatory bowel disease),386 and schizophrenia are in fact multiple diseases. Diabetes is a syndrome that can arise from causes such as defective insulin receptors or defective glucose transporters or from as yet unknown metabolic problems (Chapter 17).387 Many cancers have a... 

The ability of finasteride to block the conversion of testosterone to dihydrotestosterone also makes it useful in both male-pattern baldness (15) and hirsutism related to hyperandrogenism (for example, in polycystic ovary syndrome) in women (16). 

In 44 women with polycystic ovary syndrome treated with finasteride or flutamide for 6 months the adverse effects of flutamide were reduced libido, gastrointestinal disorders, and dry skin (29). Finasteride caused reduced libido, headache, and dry skin. Dry skin was reported in 68% of users of flutamide and in only 27% of users of finasteride. 

Falsetti L, De Fusco D, Eleftheriou G, Rosina B. Treatment of hirsutism by finasteride and flutamide in women with polycystic ovary syndrome Gynaecol Endosc... 

In some instances, transdermal estrogens appear less likely to cause problems than other forms of administration. One group studied the treatment of polycystic ovary syndrome in 24 women, using transdermal or peroral administration of a combination of estradiol and cypro-terone acetate in doses comparable to those used in oral contraceptives (217). The peroral treatment led to a significant impairment in insulin secretion and action whereas the transdermal application of estrogens did not significantly influence insulin sensitivity. 

Vrbikova J, Stanicka S, Dvorakova K, Hill M, Vondra K, Bendlova B, Starka L. Metabolic and endocrine effects of treatment with peroral or transdermal oestrogens in conjunction with peroral cyproterone acetate in women with polycystic ovary syndrome. Eur J Endocrinol 2004 150 215-23. 

Urine-derived urofollitropin and recombinant FSH appear to be equally effective and well tolerated for induction of ovulation (34). However, it is unclear whether human menopausal gonadotropins have a higher risk of overstimulation and ovarian hyperstimulation syndrome than urofollitropin in women with polycystic ovary syndrome. 

Szilagyi A, Bartfai G, Manfai A, Koloszar S, Pal A, Szabo I. Low-dose ovulation induction with urinary gonadotropins or recombinant follicle stimulating hormone in patients with polycystic ovary syndrome. Gynecol Endocrinol 2004 18 17-22. 

Creatsas G, Koliopoulos C, Mastorakos G. Combined oral contraceptive treatment of adolescent girls with polycystic ovary syndrome. Lipid profile. Ann NY Acad Sci 2000 900 245-52. 

Ibanez L, De Zegher F. Low-dose combination of fluta-mide, metformin and an oral contraceptive for non-obese, young women with polycystic ovary syndrome. J Hum Reprod (Oxf) 2003 18 57-60. 

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